Adenomyosis and endometriosis are two conditions that involve the abnormal growth of endometrial tissue. With adenomyosis, endometrial-like tissue grows into the uterine muscle, whereas with endometriosis, endometrial-like tissue grows outside the uterus. It is possible to have both conditions at the same time.
In this article, we outline the similarities and differences between adenomyosis and endometriosis, the medical treatments commonly prescribed, and two natural therapies that can relieve the symptoms of both conditions.
What is Adenomyosis?
Adenomyosis is when endometrial-like tissue, which normally lines the inner uterus, is found growing into the muscular wall of the uterus. This tissue, very similar to endometrial tissue, grows within the wall of the uterus and responds to hormone fluctuations during the menstrual cycle in a similar way to the lining of the uterus.
The thickening of extra endometrial tissue during ovulation and its bleeding during menstruation can result in chronic pelvic pain, heightened menstrual pain, and a variety of other symptoms.
That said, some women have adenomyosis without any obvious symptoms, experiencing only mild discomfort. When symptoms do occur, they commonly include:
- Pelvic Pain that intensifies during menstruation
- Severe cramping
- Heavy & prolonged periods
- Spotting between periods
- Painful sex (dyspareunia)
- Lower abdomen pressure (due to an enlarged uterus)
- Infertility or difficulties getting pregnant
Adenomyosis or Endometriosis – Which Do You Have?
Due to the similar symptoms of adenomyosis and endometriosis, it can be challenging for healthcare practitioners to diagnose one condition above the other without further investigation. On top of that, women with either condition can often put their symptoms down to painful menstruation and get on with life by using pain medication.
Research reveals that approximately 11% of women of reproductive age are diagnosed with endometriosis, although given the number of women who don’t discuss their symptoms, the percentage is believed to be much higher in reality.
Due to conflicting classifications, differing diagnostic measures, and under-reporting by patients, it is difficult to pinpoint how many women suffer from adenomyosis, however, it is thought to affect 5%-70% of women. However, adenomyosis is believed to subside once women are in menopause and estrogen levels fall.
If you regularly suffer from heavy menstrual bleeding and recurring pelvic pain that requires ongoing pain medication, think about setting up an appointment with your healthcare practitioner to investigate the possibility of adenomyosis or endometriosis.
How are Adenomyosis and Endometriosis Diagnosed?
Adenomyosis is normally diagnosed after a transvaginal ultrasound shows the growth of misplaced endometrial tissue within the muscular wall of the uterus.
Endometriosis is a little trickier to diagnose because endometrial lesions are not always clearly detected by an ultrasound. The only sure way to diagnose endometriosis is with the help of a minimally invasive surgery called a laparoscopy, where lesions and cysts are removed and tested in a lab.
It is also possible to have both conditions at the same time.
What Causes Adenomyosis and Endometriosis?
Researchers have not yet identified the exact cause of either condition; however, it has been concluded that both conditions are dependent on high estrogen levels.
One theory suggests endometriosis is genetic and endometrial cells outside the womb are formed during fetal development.
A common theory linked to the cause of adenomyosis is the possible existence of a disturbance or defect between the muscular wall of the uterus and the layer of the endometrial tissue. For this reason, women who have undergone a D&C, fibroid removal surgery, or C-section are often considered at higher risk of developing adenomyosis.
Adenomyosis and Endometriosis: Similarities
The most obvious similarity between adenomyosis and endometriosis is that both conditions involve the abnormal growth of endometrial-like tissue. With adenomyosis, endometrial-like tissue grows within the muscular wall of the uterus. Whereas with endometriosis, endometrial-like tissue grows outside the womb, most commonly on organs located within the pelvic cavity.
The misplaced endometrial tissue associated with adenomyosis and endometriosis responds to the rise and fall of estrogen and progesterone during the menstrual cycle, resulting in symptoms that are common to both conditions.
Symptoms shared by both conditions include pelvic pain that intensifies during menstruation, heavy periods, and infertility issues.
Both conditions are also known to affect women during their reproductive years. Endometriosis is known to occur in women aged 14-45, often beginning with the first period. Although adenomyosis is known to occur in young women too, it is most common in women aged between 40 and 50.
The first line of treatment for both conditions is often hormonal birth control to regulate the menstrual cycle and reduce the severity of painful menstruation and other symptoms.
Treatment Options for Adenomyosis vs Endometriosis
When it comes to treating adenomyosis and endometriosis, treatment options can vary depending on the severity of symptoms in each patient, as well as whether they hope to get pregnant or not.
Hormonal Contraceptives
Due to the fact that both adenomyosis and endometriosis are estrogen-driven and symptoms are directly related to hormone fluctuations throughout the menstrual cycle, the first line of treatment is typically hormonal birth control. Containing both estrogen and progesterone, hormonal contraceptives help to regulate the menstrual cycle and lighten or stop menstruation, thereby alleviating symptoms.
For patients hoping to start a family, regular menstruation can be sustained for a few months after coming off hormonal birth control. This provides women with a chance to conceive before symptoms typically kick back in, although fertility treatment may also be suggested during this time.
Progesterone-Only Hormone Therapy
Some patients cannot take estrogen due to an increased risk of cardiovascular disease, breast cancer, or uterine cancer. In these cases, progesterone-only therapy might be prescribed to thin the uterus lining and lighten or prevent regular menstruation to reduce the severity of symptoms.
Gonadotropin-releasing Hormone (Gn-RH) Agonists and Antagonists
If pain and severe symptoms persist after hormone therapy, women who are not hoping to get pregnant have the option of taking Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. This can ease the symptoms of adenomyosis and endometriosis by stopping the production of estrogen and shrinking endometrial tissue growing outside and within the wall of the uterus.
Gn-RH also induces temporary or artificial menopause meaning patients often suffer a whole other list of symptoms including hot flashes, mood swings, loss of libido, and vaginal dryness. Additionally, due to the loss of bone density that occurs with reduced levels of estrogen, it is recommended that Gn-RH is taken for no longer than three months at a time and only for as long as 24 months in total. Unfortunately, symptoms often return once patients stop taking the medication.
Surgery
When hormone therapy doesn’t alleviate symptoms, healthcare practitioners may suggest surgery to remove the endometrial growths that cause adenomyosis and endometriosis.
Adenomyomectomy is a surgical procedure that is performed to remove abnormal tissue associated with adenomyosis. For the majority of women, this type of surgery can successfully relieve the symptoms. If not, a hysterectomy may be suggested to permanently remove the uterus.
Although laparoscopy is normally performed to diagnose endometriosis, the same surgery is typically used to remove endometrial implants and reduce symptoms. Unfortunately, as many as 50% of women experience the re-growth of endometrial lesions outside the uterus after surgery to treat endometriosis. Because it is a condition that exists outside the womb, having a hysterectomy is also not a sure way to end the symptoms of endometriosis.
Physical Therapy
The ongoing pelvic pain linked to adenomyosis and endometriosis can often cause the pelvic floor muscles to spasm due to signals from the brain that the area is at risk. Tight or spasming pelvic floor muscles can worsen symptoms of both conditions, as well as tighten vaginal muscles and lead to vaginismus, as well as frequent urination.
Regular pelvic physical therapy can help to relax tight pelvic floor muscles thereby relieving the symptoms of adenomyosis. Pelvic physical therapists also show patients how to self-massage for relief at home.
Pelvic Wands & Vaginal Dilation
Whether instead of surgery for adenomyosis and endometriosis or post-surgery, pelvic wands and vaginal dilators are helpful tools to reduce symptoms like chronic pelvic pain and painful intercourse. Designed by pelvic health experts to relax spasms in the pelvic floor and vaginal muscles, they also help to improve natural lubrication, alleviate vaginal dryness, and reduce the fear of vaginal penetration after years of pain.
Schedule an appointment with a physical therapist specializing in pelvic health to understand how pelvic wands and vaginal dilation can help your symptoms.
Conclusion
Adenomyosis and endometriosis are both estrogen-driven conditions, causing similar symptoms due to the abnormal growth of endometrial tissue. While most women are eventually diagnosed with one or the other, it is possible to have both conditions at the same time.
Hormone therapy to regulate or prevent the menstrual cycle along with pain medication to manage pelvic discomfort is often the first line of treatment. Surgery may be suggested if medical treatment does not alleviate symptoms. Relief from adenomyosis and endometriosis can also be found in a natural way through the regular use of natural therapies like pelvic wand massage and vaginal dilators.
References
Mayo Clinic – Adenomyosis - https://www.mayoclinic.org/diseases-conditions/adenomyosis/symptoms-causes/syc-20369138
Office on Women’s Health – Endometriosis - https://www.womenshealth.gov/a-z-topics/endometriosis
Brigham and Women’s Hospital - Medical Treatments for Endometriosis - https://www.brighamandwomens.org/obgyn/infertility-reproductive-surgery/endometriosis/medical-treatment-for-endometriosis
Science Direct - Uterine adenomyosis and adenomyoma: The Surgical Approach - https://www.sciencedirect.com/science/article/pii/S0015028218300323
Physiopedia – Endometriosis - https://www.physiopedia.com/Endometriosis
Verywell Health - Endometriosis Recurrence After Surgery - https://www.verywellhealth.com/signs-of-endometriosis-returning-7375388